your doctor

Supplements aren’t proven

Frequently doctors or western medicine scientific people will say that supplements aren’t proven to do anything.  I have met doctors and other medical professionals, nurses who believe this.   Western medicine does work.   The scientific method does work.   If science says something does or doesn’t work then in most cases, the way we do science in medicine today it is true.  Double blind studies and clinical trials are well established and true.

The problem is that good trials cost a huge amount of money.   Unless you can make hundreds of millions from a drug it is unlikely anybody will ever do a real study.   So, the number of things truly studied well is necessarily limited.  Instead, we have a few well done studies and numerous less rigorous studies.   The fact that something hasn’t been studied doesn’t mean it doesn’t work.   5,000 years of Chinese medicine based on anecdote has uncovered some medically useful and obviously active products.  So, because something doesn’t have a $100 M study behind it doesn’t mean it doesn’t do something useful and powerful.   It just means nobody could make enough money to justify a big study or nobody has gotten around to doing a less expensive study yet.

If you read that some food or product will cure cancer then that is surely wrong.   It’s impossible any one thing we find in the natural world is likely a cure for the most terrible diseases we face or we would have found it a long time ago.

Western medicine is better at serious crisis cures and everybody would admit it is not as good at prevention.   In my opinion by the time something has gotten to a crisis it is way too late and usually from the point of some serious crisis intervention is required we are looking at a serious drop in quality of life.   If you face heart disease, cancer, diabetes, liver failure, etc… western medicine may save you but if there is anything you could have done to prevent these maladies you would be way better off.  The reason is that your quality of life after these diseases have occurred is substantially poorer.   Frequently you constantly are on some severe medication that limits you in some ways, you can’t eat things, you can’t do things.  You may have organs removed, you may have twitches, disfigurement, disabilities. Frequently for the rest of your life after the serious malady your quality of life is compromised in serious ways.  If you are like me you want to do whatever you can to prevent you ever getting to these diseases as long as possible.

Yet traditional medicine offers virtually nothing to help you with prevention.

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Studies and Scientific Evidence

However, can we rationally take supplements without the ultimate proof studies that medicine demands?

I categorize information into buckets of surety.   Things we can be certain about, things we have evidence that highly supports efficacy and evidence that logically makes sense.   It then becomes a matter of trying such supplements yourself and seeing if you see the effect.   Remove the supplement and does the effect go away.  Do this one at a time.   Even if it is something you can’t be sure about there is a risk/reward tradeoff.   In your own case you can decide if the potential benefit is worth the risk you are wasting money.  You probably waste money doing things bad for you.  Why not waste a little money on things that might be very good for you, that might help keep your quality of life high for a longer time?   I think that is worth a lot if it is possible.

Sure Category

Some things are rock solid worth doing and basically proven.   For most people, for instance taking Vitamin D3 supplements is a no-brainer.  D3 is not easily obtained in food.  It mostly requires sunlight, however sunlight is damaging to the skin.  Also, many people live in regions where sunlight isn’t always available every day and maybe you don’t always have the time to go out and absorb sun.  Sun exposure not only ages the skin but causes cancer.  Protecting the skin reduces the D3 from sun.   The benefits of D3 are well established including a 30% reduction of cancer risk and numerous other benefits.  Therefore, I think nearly 100% of the population should take D3 supplements at a minimum.   Several other supplements fit into this profile.  Aspirins benefit is extremely well established.  Omega3 fish oil. There are many things in this category I won’t belabor.  For instance folic acid and a lot of things that people do get a lot of normally.

Things that are not proven that many people think are

Anti-oxidants:  There is very little evidence for the theory of antioxidants.  There is no doubt that oxidized chemicals can do damage to the body.  However, there are a wide wide class of anti-oxidants and the process of de-oxidizing a chemical and removing it from the body is complicated. If a part of this process becomes overwhelmed with an Anti-oxidant then it is theorized the whole process can get stopped leaving more oxidized chemicals in the body.   There is not good scientific evidence backing the general idea of anti-oxidants although individual chemicals may themselves be good.

Vitamin C has been studied a lot and I don’t think what I’ve read justifies taking a lot of it.  It doesn’t help with colds or cancer or anything that much compared to other things you can do easily in my opinion.

Can’t I just eat well?  Won’t that be enough?

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Balanced diet.  Low fat diet, low carb diet, low protein diet.  There is no scientific evidence that eating in any specific manner produces much better results.   The body has a super ability to turn one type of food into another.  It can produce energy from any food and extract nutrients from a wide variety of foods.    Classifications of foods by food groups is arbitrary human grouping that it is unlikely to be beneficial to remove certain groups.

Dieting in General.   Eating less food than your body needs stresses your body.  There is real evidence that during diets you are at much higher chance of dying.  Constant up and downs of weight are known to cause diabetes even in non-obese people.   I’ve known some friends who’ve gotten this.  My philosophy is to diet very infrequently, maybe a few times in your entire life and to choose a way of eating that you can do for the rest of your life and stick with it.   In my opinion it is not worth dieting.  You should just realize that you need a diet that is sustainable for your entire life.

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If you rob your body of specific foods by eating say bananas exclusively for a time to lose weight I believe you are damaging your body by depriving it of essential materials.  It would be critical if you undertake these special diets to supplement the diet with lots of the supplements I talk about here.

I believe people who say they “eat well” are either highly disciplined ascetics or lying.  To eat well every day, to get all the nutrients your body needs every day is nearly impossible and would require a massive effort and discipline.    So, NO I don’t think you can do this by eating well alone.   The question is what to believe?   Many people are blocked by this.   They read one thing one day and another another day and are confused.   Isn’t it all poppycock?   No.   In my experience if you really look at the studies there are trends and things that evolve but there is still an ability to draw evidence to conclude some things will help and some things won’t.

How to interpret Studies

Studies which are less rigorous include:

1) Self-reported studies : studies where the patient reports what they remember what they did

Patients are EXTREMELY bad at remembering what they did, frequently lie.  Such studies are much worse but actually tracking exactly what people do is extremely expensive and therefore it is rare that studies do not have some of this error in them.

2) Non-double-blind studies:  studies where they only compared those taking the medicine and those not taking it

The well known placebo effect where patients who think they are taking a medicine get better (even if they aren’t)  make double blind studies important.  Just as important however is the fact that if the doctor knows who is on the study and who is taking placebo they may make slight even subconscious errors that lead to an interpretation the drug or procedure is having more of an effect than it is.

3) Association studies:  studies where they notice a coincidence that people who do this also have this happen more frequently

These studies frequently have problems that are corrupted by sheer coincidence or in many cases because of correlated behavior.  People who do X may be more likely to do Y or have some common characteristic Y unrelated to X and it may be Y which is good for you or bad for you but if all you see is the X you think X is good or bad for you when it is really Y which is good or bad.  X could do the opposite of what you think.  There is some value in association studies in that they give reasons to consider studying X to see if it alone could be good or bad but such association studies by themselves don’t really add a lot of credibility to doing X.

4) Anecdotal studies.   These are studies where people notice certain things.  It could be that they noticed like an association study that some patients did this or that and something common happened.  It could also be personal experience.  Unless you have more information, such as when the patients stopped doing X they stopped getting the benefit or problem, then they took it again and the problem reversed again then we have something more to go on.

Nonetheless 5000 years of anecdotal study of eastern herbs and medicines does mean some of them probably have merit.

5) Rat and other animal or test tube studies.   Rats have a similar genetic structure to humans in some ways but differ in substantial ways.   Frequently rats fed massive quantities of something may have a negative reaction like anything taken in large quantities.  There is quite a bit of evidence that a rat study is similar to an association study.  If something causes a rat to have cancer then maybe it is worth studying in humans but I don’t think based on that alone you can conclude anything except maybe if it is easy to avoid the thing, then sure avoid it.

Even good studies can suffer a lot of problems

There are many reasons to believe that studies even if done WELL may not tell you the whole story.   Frequently, a study may have tested the wrong dose of the supplement, the wrong combination, the wrong patients, the wrong condition.   All these things done differently can produce an entirely different outcome.   This is why in drug studies they have phases.   Phase 1 determines if the drug has efficacy and they will test a drug against severely ill patients near death in many cases.  If a drug helps some people they may go to Phase II where they test different amounts of the drug on different patients.  This is a difficult phase because some patients get too little or too much and get no benefit when the drug really does help people.   Phase III is the real test against other procedures to determine if it is worth doing compared to existing therapies.

Notice that these kinds of studies are not well suited to prevention methods or supplements.

How to use studies

When you see a study first figure out what kind of study it is.  How reliable is it? Who did the study?  Was it published in a reliable peer reviewed publication?   What are the weaknesses and strengths of the study?    Is it a good solid double blind study that tests a supplement against the right condition in the right people at the right dose.    If such a study has been done then that is great however, many times what we have are studies like I describe above with flaws.   What I look for is how many people in the study?    Are there other explanations for the result, i.e. is it possibly simple coincidence?   Is the result significant?  How long did they follow the patients?   What else were the patients taking?  What were they testing for?

Let’s look at an example:

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Study: Resveratrol shows promise to protect hearing, cognition

This study is pretty vague.  It talks about reducing inflammation in rats.  Resveratrol seems to work really well with rats.  Numerous rat studies have shown really good results with rats.  The results with humans have been much less clear.  So, the fact that rats responded so well doesn’t necessarily mean humans will have the same benefit.    The study was also very strange in that it looked to see the effect of inflammation on rats.   From the study I would suspect any anti-inflammatory would produce a similar effect.  Possibly some may work better than resveratrol.

The study is not negative.  It supports prior work with resveratrol that showed positive effects and activation of hundreds of genes but by itself this study wouldn’t make me change my recipe one way or another.

If this study had been negative, i.e. there was no benefit to hearing then I wouldn’t have changed my recipe either because I am not looking at resveratrol as a major anti-inflammatory nor to protect my hearing.  I think Pine Bark is better at the latter and aspirin better at the former.  Nonetheless Resveratrol has had numerous studies that have all had a pretty positive result so I will keep it in my recipe too.

How to incorporate study results in your life?

If the evidence for something seems to be building in a number of studies I may decide to add it to my recipe tentatively.    If it something I can tell if it is working then I can try taking it off for a period and see if the benefit seems to go away.    If I am satisfied I will keep it in the recipe.

If I see a negative study that invalidates a claim I believed was true I will take it very seriously.  In many cases the positive benefit may be marginal for a certain supplement in which case a negative study removes any rationale for taking the supplement.  I remove it from my recipe almost immediately and wait for any new evidence contradicting.

A good example of this process is how I have played with naicin in my recipe.   Originally when I started taking Niacin 20 years ago all we knew was that niacin reduced LDL and increased HDL.  There are 3 types of niacin.   The effect of niacin is indisputable.  It is directly measurable in blood tests and acts similar to statin drugs.  I took all 3 forms of niacin.  2 of the forms didn’t cause a flush reaction (inositol bound niacin, timed release).  1 form had more liver impact than others (timed release), 1 caused a flush and could only be taken in lower doses (niacinimide).   I got good results from taking all 3 but reading studies it became apparent that inositol niacin didn’t leave much results in the blood supply so I removed this and increased the other 2 forms.  Eventually studies came out that showed that slow release niacin did more damage to the liver and also left less niacin in the blood.  I moved to all niacinimide and stopped the slow release form.  I now take less niacin but amazingly the blood results are better than ever with no liver risk.

Over time I have put things in, taken them out.   Sometimes I have put them back in when evidence seemed to mount again.  The fact that there are insufficient quality studies is depressing.  I wish we could find good studies on all the supplements.

BigData and the Future of Medicine

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I am hoping over the next 10-20 years we will see the emergence of data from people using various monitors and people on the internet agreeing to give their health data.   The purpose of this is to collect vastly more data than is available today on usage of supplements, drugs and consequences.  If we could gather information across millions of people reliably it would transform medical care and potentially have a huge impact on health and medicine costs.  Trials are the most expensive part of drug studies and limit the value of supplements.

I hope some enterprising people out there will sponsor studies of this type and that people will participate and give up important medical information to help all of us have better lives.   I will definitely let people know if I find something for all of us interested in our health to participate in improving our health.

Here is a cool app I imagine to help us all

Vivino is a very cool app.  If you drink wine consider getting this app.   All you have to do is point your phone at a bottle of wine, press a button and it will tell you all about the wine.

I imagine a similar app for supplements but much more sophisticated:

1) I want to be able to point an app at a bottle of some supplement and have it find everything there is to know about that supplement.  All the ingredients.

2)  I would like it to then allow me to add it to my recipe

3) do research on studies on the ingredients

4) pull up pricing and alternative suppliers

5) quality as consumerlabs.com would review it.

.6) I would like to then be able to see if I add it to my recipe what my total intake of all ingredients would be.

7) I would like to see if the supplement should be taken morning or evening, with food or without

8) Any interactions of the supplement with conditions or other medicines or supplements

9) If I add it to my recipe I would like to be placed on a list of other who take it so we can accumulate information on our experience with it and how much we took and what other things we took in conjunction with it

10) I would like to be able to contribute information on my experience

11) If I have a tracker I would like to have this go into a bigdata farm so that we could do analysis on long term effects of the supplement on our health and well being.

Summary

I hope you found this interesting.   Supplements absolutely can help you improve your quality of life.

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